Friday, February 14, 2014

PARADIGM BYTES February Issue

PARADIGM BYTES

Newsletter for Paradigm 97
February 14, 2014
PARADIGM DEFINED:1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.

Our website...... http://paradigm97.blogspot.com/Please copy, paste, and bookmark it.

MISSION STATEMENT
We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.
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SNIPPETS
 
With many hospital staffing cuts today, professional nurses end up clocking in longer shifts and skipping breaks. And as the tragic story of Beth Jasper shows, it has horrible consequences.
Beth Jasper, a 38-year-old registered nurse at Jewish Hospital in Cincinnati, was one of the few nurses at that facility who was certified to work on the dialysis machines in the bone marrow transplant unit. In 2011, Jewish Hospital came under the ownership of Mercy Health Partners of Southwest Ohio and subsequently made staffing cuts.
This nursing shortage caused Beth’s shifts to be extended, routinely and significantly exceeding the hours for which she was scheduled. Frequently, she was called into work during her off time and often asked to work extra shifts. She would work through her breaks and sometimes would hold off bathroom breaks for extended periods of time. She did inform her supervisor that she was under great stress and that she was “being worked to death.”
After a long shift, Beth was driving home in the early hours of March 16, 2013, when her vehicle suddenly left the road and crashed into a tree. She was survived by two children and her husband who has since filed a suit regarding her death. This is so tragic that it’s difficult for me to even write about this.
Who is Liable?
I’m not going to comment on the allegations in the lawsuit. What I want to share is that I am in no way blaming Beth Jasper for what happened. As nurses, we feel such a loyalty to our hospital or facility and such a dedication to our patients that sometimes we feel that we have no other choice. It’s a really difficult job market for nurses and nurses are afraid to even say something.
What would have happened if Beth refused to come in on her off shifts? What would have happened had she refused to stay late? What would have happened if she refused to work extra shifts? Would the hospital have found somebody else willing to work all those hours? Would someone else have agreed to do it? These are all questions that have no answers.
But what is known is that Beth was experiencing too much stress and that she was working an excessive amount of time. She knew she was not taking her breaks, not eating, and wasn’t even taking time to go to the restroom during her shifts. We also know that research shows that the quality of patient care drops when professional nurses are stressed out, burned out and work excessive hours.
Empowering Nurses, Empowering Ourselves
So what can we do to avoid suffering the same fate? It starts with empowerment, something that no law can automatically guarantee. Always keep in mind these excerpts from the Empowered Nurses Bill of Rights:
  • Go home feeling like you did a good job;
  • Not be pushed to work overtime because there is no one else;
  • Not be made to feel that they cannot call in sick when they are really ill;
  • Adequate staffing so that everyone has time to do what each patient requires, including psychosocial support;
  • A fair schedule with an equally number of holidays and hours compared to co-workers.
It is important for nurses to be empowered now, more than ever! Are we going to allow the legal system to decide the fate of our profession? Are we going to allow the legislature, mostly made up of lawyers, to impose rules on our profession?
Where I practice, the Indiana legislature has not mandated minimum staffing. But, if it did, would it help? What if the patients have a much higher acuity? The minimum staffing could hurt us because based on acuity, we should have more staffing.
Are we going to let unions decide our fate? I am not sure if Jewish Hospital is unionized but I am aware that hospitals in Ohio are unionized.
Instead, it is up to us to take back our profession. It is up to us to stand up and say, “We’re not going to tolerate this anymore! We are not going to do mandatory overtime! We are not going to come in when we are ill! We are not going to be forced to stay late or work extra shifts.”
Until nurses stand in their power and take control of their profession, nurses will continue to get burned out, unhealthy and sick. The worst part of it is that we are not able to provide the best patient care under those conditions.
Professional nurses, what are your thoughts?
- See more at: http://www.nursetogether.com/a-nurse-who-worked-to-death#sthash.Rc63bL51.dpuf
to stay late or work extra shifts.”
Until nurses stand in their power and take control of their profession, nurses will continue to get burned out, unhealthy and sick. The worst part of it is that we are not able to provide the best patient care under those conditions.
Professional nurses, what are your thoughts?
By Lorie Brown, Creator & Founder at EmpoweredNurses.org | RN, MN, JD | Registered Nurse | Attorney | Author | Speaker | Transformational Leader | Lorie received her BSN from Indiana University, her MN from University of California at Los Angeles and her JD from Indiana University Indianapolis. Lorie has spent her career helping nurses. She has a private law practice in Indianapolis where she represents nurses before the Nursing Board. Lorie's mission is to empower nurses to speak their mind, stand in their power and be a change agent to improve patient care. Lorie would like to know if you are an empowered nurse. Take the quiz to find out at www.areyouanempowerednurse.com - See more at: http://ec2-50-16-149-40.compute-1.amazonaws.com/health-care-nursing-professionals-speak?preview=18712#sthash.MN6R3R3Q.dpuf
About the Author: Lorie Brown, Creator & Founder at EmpoweredNurses.org | RN, MN, JD | Registered Nurse | Attorney | Author | Speaker | Transformational Leader | Lorie received her BSN from Indiana University, her MN from University of California at Los Angeles and her JD from Indiana University Indianapolis. Lorie has spent her career helping nurses. She has a private law practice in Indianapolis where she represents nurses before the Nursing Board. Lorie's mission is to empower nurses to speak their mind, stand in their power and be a change agent to improve patient care. Lorie would like to know if you are an empowered nurse. Take the quiz to find out at www.areyouanempowerednurse.com.
- See more at: http://www.nursetogether.com/a-nurse-who-worked-to-death#sthash.Rc63bL51.dpuf
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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days
Don’t get ‘caught’ in the CAUTI trap
Issue Date: December 2013 Vol. 8 No. 12
Authors: Terri Townsend, MA, RN, CCRN-CMC, CVRN-BC; Pamela Anderson, MSN, RN, APRN-BC, CCRN; and and Lois Meeker, MSN, RN, CMSRN
Even though the morbidity and mortality of CAUTI (catheter-associated urinary tract infections) (CAUTI) is low compared to other hospital-acquired infections, the high use of indwelling urinary catheters causes a large number of urinary tract infections and deaths. In fact, CAUTIs are the most frequent healthcare associated infection, accounting for 30 % to 40% of infections in hospitalized patients according to data from the Centers for Disease Control and Prevention. It’s estimated that more than 560,000 nosocomial urinary tract infections occur annually, causing significant morbidity, hospital expenditures, and increased length of stay. Mortality from CAUTIs is thought to exceed 13,000 deaths each year. Adherence to recommended infection control practices could prevent 380,000 infections and 9,000 deaths annually.
As a result of the morbidity and mortality linked with CAUTIs, the Joint Commission’s Patient Safety Advisory Group recommended development of a National Patient Safety Goal (NPSG) to focus on the need to follow evidence-based practices to prevent the problem. NPSG.07.06.01 became effective in January 2013 and addresses insertion, maintenance, and surveillance of indwelling catheters. In addition, CAUTIs are deemed a preventable complication by the Centers for Medicare and Medicaid Services (CMS) and associated treatment costs are no longer reimbursable. ...
House&utm_medium=email
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February 2-8 is Burn Awareness Week. Consider these facts.
400:
Number of children under age 10 who die in home fires each year.
30:
People can be burned in 30 seconds by a flowing liquid that is 130° F; at 140° F, it takes only 5 seconds, and at 140° F, it only takes 1 second.
120:
The temperature setting for a water heater should be 120° F or less.
2007:
Year flammability standards for mattresses were implemented; older mattresses should be replaced.
204,000:
Number of structural fires caused by gasoline that firefighters respond to each year.
Find more facts and safety tips for preventing burn injuries.
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Meditteranean diet may protect against diabetes
(Reuters Health) - Without cutting back on calories, adopting a Mediterranean diet rich in extra-virgin olive oil may protect people at high risk for heart disease against diabetes, a new study found.
Researchers who analyzed data on more than 3,500 people at an increased risk for heart disease found those who were put on a Mediterranean diet were about 30 percent less likely to develop diabetes over the next four years, compared to those assigned to a general low-fat diet.
"Randomized trials have shown that lifestyle interventions promoting weight loss can reduce the incidence of type 2 diabetes, however, whether dietary changes without calorie restriction or increased physical activity also protect from diabetes development has not been evaluated in the past," Dr. Jordi Salas-Salvado wrote to Reuters Health in an email.
Salas-Salvado is the study's lead author and a professor of nutrition at Rovira i Virgili University and the head of the Department of Nutrition at the Hospital de Sant Joan de Reus in Spain. ...
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New guidelines on healthcare personnel attire
The Society for Healthcare Epidemiology of America has issued guidance for “Healthcare Personnel Attire in Non-Operating-Room Settings,” published in the Journal of Infection Control and Hospital Epidemiology. The article includes recommendations related to bare below the elbows approach, laundering, and use of white coats. Read the abstract and an article that provides an overview of the recommendations.
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Acetaminophen Prescription Combination Drug Products with more than 325 mg: FDA Statement - Recommendation to Discontinue Prescribing and Dispensing FDA is recommending health care professionals discontinue prescribing and dispensing prescription combination drug products that contain more than 325 milligrams (mg) of acetaminophen per tablet, capsule or other dosage unit. There are no available data to show that taking more than 325 mg of acetaminophen per dosage unit provides additional benefit that outweighs the added risks for liver injury. Further, limiting the amount of acetaminophen per dosage unit will reduce the risk of severe liver injury from inadvertent acetaminophen overdose, which can lead to liver failure, liver transplant, and death.

Cases of severe liver injury with acetaminophen have occurred in patients who:
• took more than the prescribed dose of an acetaminophen-containing product in a 24-hour period;
• took more than one acetaminophen-containing product at the same time; or
• drank alcohol while taking acetaminophen products.
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Bedside Shift Changes for Nurses Can Reduce Errors, Improve Patient Satisfaction
Performing nurses’ shift changes at the patient’s bedside can reduce potential medical errors and increase patient satisfaction, according a new study highlighted on ScienceDaily.com. The study findings were published in the Journal of Nursing Care Quality.

Traditionally, nurses exchange patient information between shifts through recordings or verbal briefings. With the bedside handover method, nurses exchange pertinent patient information such as clinical conditions, allergies, and care plans with the patient in his or her room. With this system, nurses and patients see each other sooner and patients are able to ask questions and clarify information with both the nurse leaving for the day, and their new nurse. This process can relieve anxiety and improve patient satisfaction, according to the article.

Study participants described bedside handover as engaging, personal, and informative. However, researches noted the importance of recognizing and being sensitive to patients’ preferences, which often differ. Bedside handover can be beneficial for nurses as well, since they can assess all patients’ conditions and prioritize care within the first 15 minutes of a shift. ... http://inqri.blogspot.com/2013/11/bedside-shift-changes-for-nurses-can.html
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Organic food and farm groups ask Obama to require GMO food labels (To label a food as organic, no additives , or gene alteration has been done)
(Reuters) - Four U.S. lawmakers joined with more than 200 food companies, organic farming groups, health and environment organizations and other groups on Thursday to urge President Barack Obama to require manufacturers to label food products that contain genetically engineered ingredients.
The groups delivered a letter to the president dated January 16 reminding Obama of a campaign pledge the groups said he made in 2007 as he campaigned in Iowa to work to label so-called GMO foods.
The issue is hotly contested, with more than 20 states considering laws to mandate labeling of foods made with gene-altered corn, soybeans, sugar beets and other biotech crops. Currently, labeling of such foods is voluntary.
Advocates of labeling say consumers deserve to know if the food they eat contains GMOs. But the makers of biotech crops, and many large food manufacturers have fought against mandatory labeling, arguing that genetically modified crops are not materially different and pose no safety risk, and labeling would mislead consumers. ...http://www.reuters.com/article/2014/01/16/us-usa-gmo-labeling-idUSBREA0F10H20140116?feedType=RSS&feedName=healthNews

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(Reuters) - U.S. regulators on Friday approved Gilead Sciences Inc's Sovaldi, also known as sofosbuvir, as a potential cure for chronic infection with the liver-destroying hepatitis C virus.
The once-a-day pill is the first approved to treat certain types of hepatitis C infection without the need for interferon, an injected drug that can cause severe flu-like symptoms.
Hepatitis C, which is often undiagnosed, affects about 3.2 million Americans, killing more than 15,000 each year, mostly from illnesses such as cirrhosis and liver cancer.
Most patients will be treated with the $7,000-a-week drug for 12 weeks, resulting in a total price of $84,000, according to Gilead spokeswoman Cara Miller.
"Today marks a landmark advance in the treatment of hepatitis C, opening up new opportunities to stop the spread of this virus and the ravages of this disease," Dr John Ward, director of the Centers for Disease Control and Prevention's division of viral hepatitis, said in a statement. ...
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The 1975 movie Jaws fueled widespread fear and hatred of sharks, and the shark has been intensely hunted since. It is so endangered that many countries have taken steps to protect it. Ironically, the late Peter Benchley, the author of the book, supported shark conservation.


RANDOM FACT:

About two-thirds of shark attacks on humans have taken place in water less than six feet deep. Most shark attacks occur less than 100 feet from the shore. Shark attacks happen all over the world, but mainly around popular beaches in North America (especially Florida and Hawaii), Australia, and South Africa.

For every human killed by a shark, humans kill two million sharks.
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Bonus Fact:

Approximately 100 million sharks are killed every year. Shark teeth are used to make necklaces; cartilage is used to make fertilizers; skin is used to make leather; liver is used to make face cream, sap, and fuel; and fins are used to make soup. The mass killing of sharks creates a negative, cascading effect in the global environment.
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2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) FREE
Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes.
There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. ...
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Stress Test Chemicals Could Cause Heart Attacks And Death, FDA Warns Nov 20 (Reuters) - The U.S. Food and Drug Administration warned physicians on Wednesday that two chemicals used to conduct cardiovascular stress tests can cause heart attacks and death, and it suggested resuscitation equipment and trained staff be available when the tests are conducted.

The injectable products, Lexiscan and Adenoscan, are marketed by Astellas Pharma US Inc. They work by stressing the heart, allowing physicians to take images that can show areas of low blood flow and damaged heart muscle. The tests are given to patients who are physically unable to exercise.

The FDA said heart attacks may be triggered by the tests because the chemicals dilate the heart's arteries and increase blood flow to help identify obstructions. Blood flows more easily to unblocked arteries, which can reduce blood flow to an obstructed artery. In some cases, that can lead to a heart attack, the agency said.

The FDA advised physicians not to use the products in patients with signs of acute myocardial ischemia, which occurs when blood flow to the heart muscle is decreased. Some cases of heart attack and death have occurred in patients with unstable angina, or chest pain, and other heart problems. ...
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Quiz Time
When caught in a moral dilemma, taking a time-out allows you to:
a. reflect on your obligation to show moral courage.
b. reflect on what ethical principles are at risk.
c. manage your danger.
d. manage your actions.
Answer at end of Newsletter
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                                                                           Hints
 
Did you know that you can scoop up deals at the cleaners? Many dry cleaners hold a sale once or twice a year to clear
out items that haven't been picked up, so if you're in the market for some great bargains, ask your local cleaner when
their next clearance even is scheduled.
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Hint 2: Keep your sweaters from shrinking

To prevent wool sweaters from losing their shape try this easy hint. Fill your sink with warm water and mix in 1/4 cup of baby shampoo. Soak your knit in the mixture (without agitating) for about 30 minutes. Rinse your sweater out in cold water and lay flat to dry. Easy and simple, right?

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Hint 3:

Are you fighting with your hairspray bottle to get out a steady stream? The nozzle is probably clogged. Instead of
throwing out the bottle of hairspray, run the nozzle under a stream of hot water to dissolve the buildup.
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(Thank you, Roz)         Flu shot reduces risk of Autism
Greg Poland, MD, a researcher at the Mayo Clinic has been studying the flu virus for a quarter century. He says you can think of the flu vaccine as an “anti-autism vaccine.”
It’s a startling statement, but it is backed up by several recent studies. Dr. Poland says pregnant women who get influenza have double or triple the risk of having a child with autism. So preventing flu during pregnancy is vital.
The rubella vaccine also decreases the risk of having a child with autism, but the rubella vaccine must be given before a woman gets pregnant.
The flu vaccine is safe at any stage of pregnancy, but pregnant women get the flu shot, not the nasal spray. ...
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The full moon and new moon differ in several ways.

Many people wonder what the difference is between a full moon and a new moon.

With a full moon - you are seeing the entire moon in its brightest light. The moon is so bright because its position allows it to be completely lit by the sun.

The full moon will come on the 15th day of the lunar month. The new moon will come on the first day of the lunar month. The lunar month has approximately 29.5 days in it; which in effect means that we will have 1 full moon every 29.5 days.
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from RNFrankie (Frankie)
I wrote about a CNA who carefully gloved at the beginning of the shift to do her VS. One evening I noticed that she was going from one room to the next with her gloved hands up in the air similar to a surgeon going to the operating table. I spoke to her about the need to change gloves for each patient and to wash her hands before donning new gloves. She said...(are you ready for this?) I wear gloves to protect myself from their nasty diseases....and I don't need to change gloves all the time, it makes my hands sore. My manager did nothing about it....despite this CNA having been written up many times.
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This is from Cheri (ckppk): Every time I go to the supermarket deli counter, I have this sudden urge to bite my poor cuticles because of what I witness !!! Yup, they all wear gloves alright ! And w/ them on, they scratch their heads, noses, answer the phone, open the frig door, touch the counter top etc etc...and then, receive each slice of whatever DIRECTLY into their dirty hands !!! This gets me crazy, so I inevitably call them over and very quietly, so not to embarrass them, I inform them that: #1 I am connected w/ the Dep't of Health (true) and #2 They have just violated sanitary protocol re: food safety guidelines.
Then I politely request a change of gloves while they give me dirty looks.
After this I find the manager and inform him that I am an RN affiliated w/ the Dep't of Health and his staff is in violation of the health code for food safety and ask who has instructed them in proper glove technique.
This is when they tell me that none of them have had formal instruction. I ask why, and they proceed to shrug.
Do you know that I actually volunteered to instruct them because I can't take it anymore ?
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How about the night in the ER when an RN almost bolused 10 cc of air into my cousin,s body because she was ready to connect the IV tubing w/o flushing it first, and another RN who mistakenly discarded a part to an IV set up into the trash can, and reached into it w/ her gloved hand to retrieve it so she could start the IV. When confronted , she said "oh, it's ok...it's still wrapped ! So, with gloved hands, she was about to touch and use equipment which was touching garbage simply because the OUTSIDE was the only part that was no longer clean. Is she kidding me ??
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Years ago, I was out to dinner with 3 friends at their favorite "Olive Garden" restaurant. While we were waiting for our dinner, the table next to us was vacated.
The busboy (man) began to clear off the table of the dinnerware, silverware, glasses, etc. He then reached into his back pocket...NO GLOVES...and hauled out his rag to wipe off the table. Since it was a table for 4, he had to go around it. I was absent-mindedly observing him when I saw him wipe half of the table....then BLOW HIS NOSE INTO THE RAG...and then continued wiping down the rest of the table! I have not been able to set silverware onto a table in ANY restaurant since then. I ALWAYS ask for more napkins and lay my silverware on that. If no napkin appears, I simply wait until my meal arrives and then I place the extra silverware on the rim of the plate!

I also told the maitre' d of the incident and he was horrified! He told us that he was going to report it to management, etc. Several weeks/months later, we were in again and he made it a point to tell us that management "had taken care of the situation and I assure you it won't happen again." My take?....I think they just fired the guy. Cheri (ckppk@AOL.com)
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This was sent in by Marlene (MarGerlach) who writes: 'I have seen so many of these things go on, I can't even begin to recall them, but reading about the shops, deli, etc...reminds me of the time a friend and I went to lunch at "Old Country Buffet." As we sat there eating we watched a clean-up person go around to wash off the tables that people had used. I was incredulous as I watched her wipe the table with her damp towel, then the vinyl seat cushions of the booth , and THEN....still with the same cloth, not even reversing it, not that it would help....she wiped off the tops of the salt and pepper shakers. Then she proceeded to the next booth to do the same with the same towel all the time. So now we are shaking salt and pepper thru the shaker holes that have people's (butt) germs on them . I did tell the manager how disgusting and unsanitary this was and either stop it immediately and permanently or get reported to the health dept..
One of my pet peeves in hospitals are pillows that fall on the floor, get kicked around a bit and then get placed back under the patient's head. "Could we please change the pillow case first????????" How dirty is a hospital floor??
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Thumb washing:
1) Taylor, IJ (1978) An evaluation of handwashing techniques. Nursing Times 83,
683-690. Showed that parts of the thumbs, backs of fingers and hands, and web
spaces are usually missed.

2) Elaine Larson, formerly at Stanford and for years at (I think) Columbia, has
many papers on handwashing. Here's one: Larson EL (1985) Handwashing and skin.
American Journal of Infection Control 6(1) 14-23
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(Take the time to read this study....very interesting)
Fever-reducing drugs may help spread flu
According to a study in Proceedings of the Royal Society B, the widespread use of fever reducing medications may lead to more cases of, and deaths from, influenza. The reason is that fever can help decrease the amount of virus in an ill person’s body. Read the study abstract and read an article about the study. ...
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Breast Cancer: Don't Delay Chemo     Delaying adjuvant chemotherapy for breast cancer more than 60 days significantly increased the odds of premature death and distant metastasis, a review of almost 7,000 cases showed.
As compared with starting adjuvant therapy within 30 days of surgery, initiating chemotherapy at 61 days or later was associated with a 19% increase in the risk of premature death. In the subgroup of patients with stage III disease, the mortality risk increased by 76%. Relapse-free survival (RFS) and distant relapse-free survival (DRFS) worsened regardless of stage at diagnosis, according to Mariana Chavez-MacGregor, MD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues. ...
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A "Secret Sentence" you can use to land more job interviews and job offers?
HR at E3 Consulting
While The Other Applicants Wait By The Phone Hoping For It To Ring... You'll Be Booked For A Month Solid With Quality Job Interviews! A very unusual Cover Letter Video for job seekers. Click Here: http://tinyurl.com/kmzeg8z (video...long one.)
                                                                                                   
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Here are some facts about hypertension among adults in the U.S. based on a data brief from the National Center for Health Statistics:
29.1%:
Prevalence of hypertension among U.S. adults aged 18 and over
42%:
Prevalence of hypertension among non-Hispanic black adults
28%:
Prevalence of hypertension among non-Hispanic white adults
26%:
Prevalence of hypertension among Hispanic adults
83%:
Among adults with hypertension, nearly 83% are aware, nearly 76% are taking medication to lower their blood pressure, and nearly 52% are controlled.
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U.S. Panel Backs Routine Lung CT Scans for Older, Heavy Smokers (HealthDay News) --
 
A highly influential government panel of experts says that older smokers at high risk of lung cancer should receive annual low-dose CT scans to help detect and possibly prevent the spread of the fatal disease.
In its final word on the issue published Dec. 30, the U.S. Preventive Services Task Force (USPSTF) concluded that the benefits to a very specific segment of smokers outweigh the risks involved in receiving the annual scans, said co-vice chair Dr. Michael LeFevre, a distinguished professor of family medicine at the University of Missouri.
Specifically, the task force recommended annual low-dose CT scans for current and former smokers aged 55 to 80 with at least a 30 "pack-year" history of smoking who have had a cigarette sometime within the last 15 years. The person also should be generally healthy and a good candidate for surgery should cancer be found, LeFevre said. ...
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Acid-Reflux Drugs Tied to Lower Levels of Vitamin B-12Long-term use of proton pump inhibitors and histamine-2 receptor antagonists to treat acid reflux was associated with a 65% and 25% greater risk of vitamin B-12 deficiency, respectively, according to a study published in the Journal of the American Medical Association. The risk of B-12 deficiency increased with both dosage and length of usage. "Our study doesn't recommend stopping those medications, but you should take them at the lowest effective dose," study author Dr. Douglas Corley said. HealthDay News ... http://consumer.healthday.com/gastrointestinal-information-15/gastrointestinal-problems-news-330/popular-reflux-drugs-tied-to-vitamin-b-12-deficiency-682925.html
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Guidelines cover vaccination of immunocompromised patients New guidelines released by the Infectious Diseases Society of America stress the importance of the influenza vaccine and other vaccines for immunocompromised patients, including those with HIV and cancer. According to the guidelines, which were published in Clinical Infectious Diseases, vaccination rates are lower among these patients partly because their physicians may be concerned about the safety and effectiveness of these vaccines. There has not been a comprehensive set of guidelines that addresses all vaccinations.
Most vaccinations are covered in the guidelines, including Haemophilus influenzae type b, hepatitis A, diphtheria-tetanus-acellular pertussis, tetanus-diphtheria-acellular pertussis, HPV, influenza, measles-mumps-rubella, meningococcal, pneumococcal, polio, rotavirus, varicella and zoster.
Among the most notable recommendations is that most immunocompromised patients aged at least 6 months should receive an annual influenza vaccine, but not the live-attenuated vaccine nasal spray ...http://www.healio.com/infectious-disease/practice-management/news/online/%7B4f8d548e-d5ca-4090-af70-af8d97e8cb33%7D/idsa-guidelines-urge-vaccinations-for-immunocompromised-patients
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ADVANCES IN RHEUMATOLOGY BREED A NEW NURSING SPECIALTY
The study of rheumatic disease dates back to the early 1800s with the discovery of rheumatic fever. Since then, much has been learned about other rheumatic conditions – chronic conditions usually caused by inflammation and often characterized by swelling or joint and muscle pain – including rheumatoid arthritis, psoriatic arthritis, lupus and gout. The largest advances in treatment, however, came about in the late 1990s with the advent of new types of therapies...
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Vitamin E may slow early Alzheimer's decline: study
NEW YORK (Reuters Health) - Taking vitamin E during the early stages of Alzheimer's disease slowed declines in patients' ability to perform basic tasks by about six months in a new study.
For example, the researchers write in JAMA, past research has found the vitamin slowed disease progression in people with moderately severe Alzheimer's. But the vitamin was not effective at slowing the transition to Alzheimer's for people with so-called mild cognitive impairment, which typically precedes Alzheimer's.
To see whether vitamin E - or a combination of the vitamin with memantine, a drug approved in the U.S. to treat Alzheimer's - would slow the rate of decline in people with mild to moderate forms of the disease, the researchers recruited 613 trial participants from 14 Veterans Affairs medical centers. ...
                                                                                                                                                                                                                
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                                                      HUMOR SECTION

After 35 years of marriage, a husband and wife came for counseling. When asked what the problem was, the wife went into a tirade listing every problem they had ever had in the years they had been married. On and on and on: neglect, lack of intimacy, emptiness, loneliness, feeling unloved and unlovable, an entire laundry list of unmet needs she had endured.
Finally, after allowing this for a sufficient length of time, the therapist got up, walked around the desk and after asking the wife to stand, he embraced and kissed her long and passionately as her husband watched - with a raised eyebrow.
The woman shut up and quietly sat down as though in a daze. The therapist turned to the husband and said, "This is what your wife needs at least 3 times a week. Can you do this?"
"Well, I can drop her off here on Mondays and Wednesdays, but on Fridays, I fish."

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    CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........
Get to know the international sepsis guidelines Nursing Made Incredibly Easy!,January/February 2014
Expires: 2/29/2016
- See more at: http://www.nursingcenter.com/lnc/CEArticle?an=00152258-201401000-00009&Journal_ID=417221&Issue_ID=1646738#sthash.SkkU4trS.dpuf
Abstract Familiarize yourself with the Surviving Sepsis Campaign's updated recommendations for the care of patients with sepsis or septic shock.Sepsis is defined as a systemic inflammatory response associated with bacterial infection that encompasses a series of clinical events, which play a vital role in the progression of sepsis to severe septic shock and influence the development of multiple organ dysfunction syndrome, including respiratory distress, hypotension, cardiac arrhythmias, bleeding complications, and low or absent urine output. As each successive organ fails, mortality dramatically increases. -
_________________________________Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member.
Please follow me on Twitter as Dr Robert Hess.
Pay Only $34.99 for a full year of CONTACT HOURS
www.nurse.com for CNE offerings.
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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com.
This is an excellent nursing site, check it out:http://nursingpub.com/

Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell) Founder, Forum for Shared Governance
info@sharedgovernance.orgwww.sharedgovernance.org

Decubqueen's website: www.accuruler.com
RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm
H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007
Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263
If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood

 Metric conversion calculators and tables for metric conversions
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MEDICAL RECALLS
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Lidocaine HCl Injection 2%, 5 ml Vial by Hospira: Recall - Presence of Particulate Matter Hospira initiated a voluntary nationwide recall to the user level for one lot of Lidocaine HCl Injection, USP, 2%, 5 mL Single-Dose Vial (NDC 0409-2066-05), Lot 32-135-DD, expiration date 1AUG2015. The recall is due to a reddish orange particulate on the inner surface and floating in the solution.
If particulate goes undetected and solution is administered, the particle may potentially block the infusion of the solution to the patient, resulting in a delay in therapy. If smaller pieces of the particulate break off and become free floating within the solution, they may pass through the catheter into the patient, resulting in local inflammation or mechanical disruption of tissue. Chronically, following sequestration, local granuloma formulation is possible. In consideration of the reddish orange color of the particulate, if there is iron within the particle that is infused, it may put a patient at risk when undergoing MRI (strong magnetic field exposure), as the particle could potentially be dislodged and be pulled through tissue, causing local inflammation and tissue trauma.
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Puritan Bennett 840 Series Ventilator by Covidien - Class I Recall - Software Problem
FDA notified healthcare professionals of a Class I recall of the Covidien, Puritan Bennett 840 Series Ventilator. Due to a software problem, a diagnostic code (XB0069) may be triggered. This causes the ventilator to stop functioning, triggering the safety alarm and causing the patient to suddenly be required to breathe on his or her own. This product may cause serious adverse health consequences, including death.
These devices are used on critically ill patients who may not be able to continue breathing without the ventilator. The affected Software Part Number is 4-070212-85, Revision AB-AG, Manufactured: April 30, 1998 to March 12, 2010 and Distributed: August 1, 2008 to October 31, 2010.
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Baxter Dual Luer Lock Caps: Class I Recall - Presence of Loose Particulate Matter Found In Packaging Baxter International Inc. announced it has initiated a voluntary recall of two lots of its Dual Luer Lock Caps (Product Code 2C6250, Lots 10043 and 10044) because of the presence of loose particulate matter found in the packaging. Particulate matter entering the fluid path from the Luer Lock Caps may result in thrombotic and embolic events, including: pulmonary embolism, myocardial infarction and stroke. There have been no reported complaints associated with this issue, however embolic events may not be easily attributed to such particulate matter. The root cause has been identified and resolved. FDA has designated this as a Class I recall. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm369288.htm
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ADVERTISEMENTS
from the members
This ad is from Decubqueen (Gerry)..........Accu-Ruler Accurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.
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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
rogerswhitney@yahoo.com      Whitney    January 27, 2014
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NOTICE:
I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address. So, be certain to let me know when you change your address. RNFrankie@AOL.com
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EDITORIAL STAFF:
GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan)

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PARADIGM 97 CO-FOUNDERS:
MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie)

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DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views.
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THOUGHT FOR THE DAY
“No act of kindness, no matter how small, is ever wasted.” - Aesop
Why don't you write???    Send me articles/ thoughts
Frankie

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